Modulation of liver tumor blood flow with hepatic arterial epinephrine: a SPECT study

Changes in the relative arterial flow to hepatic tumors and adjacent normal liver, in response to varied doses of hepatic arterial epinephrine, were studied with single photon emission computed tomography. In 18 patients with known hepatic tumors, hepatic artery perfusion scans were obtained with the concurrent infusion of technetium-99m-labeled macroaggregated albumin and escalating doses of epinephrine (0-10 micrograms/min). Regions of interest were drawn around tumor and adjacent normal liver in three planes, and the average tumor-to-liver ratio (T:L) was calculated. In all 18 patients, there was a measurable baseline T:L perfusion advantage (range, 1.7-18.7; mean, 4.8). In 12 of 18 patients, this ratio increased with epinephrine (range, 1.1-53.6 times the baseline value; mean, 7.1). In six patients, no improvement in T:L could be demonstrated. In 14 patients the lung shunt index, a measurement of arteriovenous shunting, increased with escalating doses of epinephrine. This pilot study suggests that the infusion of epinephrine may improve the therapeutic index of certain regional therapies such as bolus drug infusions, hepatic arterial embolization, and radioactive microsphere therapy.